Robotic Surgery in Benign Gynecologic Indications
Can someone please share the history and current practices of Robotic Surgery in Benign Gynecologic Indications ?
@ushika Gynecologic surgery has undergone a significant evolution over the past few centuries.
The first planned hysterectomy was a vaginal hysterectomy performed by Osiander of Gottingen in Lower Saxony in Germany in 1801. Since then, the techniques of gynecologic surgery have been significantly enhanced and the complications reduced.
Laparoscopy was introduced in gynecology in the 1940s. It was not until 1988 that the first laparoscopic-assisted vaginal hysterectomy was performed by Harry Reich in Pennsylvania. Many criticized this procedure because of the complexity of the technique, along with the lengthy operating time. Eventually, technology evolved, and the laparoscopic approach led to decreased hospital length of stay and faster postoperative recovery with minimal differences in postoperative morbidity or mortality.
Robotic surgery in gynecologic procedures began when the da Vinci surgical system was approved by the US Food and Drug Administration (FDA), and the first gynecologic surgery was performed in 2005. Since then, the number of minimally invasive gynecologic procedures has increased dramatically, with the number of robotically assisted hysterectomies surpassing the number of hysterectomies performed with conventional laparoscopy.
Since the inception of a robot by Leonardo da Vinci in 1495, the field of robotics has expanded into many areas, including the automobile industry, space exploration, military, and medicine. The evolution of robotic systems in surgery began in 1985 with the use of a robotic arm called the PUMA 560 for a stereotactic brain biopsy. Different models based on inputting preoperative designs for surgery into the robotic device were then developed and applied in the fields of general surgery for transurethral resection of the prostate (PROBOT) and orthopedics for hip replacements (ROBODOC). Robotic telepresence technology was then conceived to provide immediate operative care remotely to wounded soldiers on the battlefield.
In 1994, AESOP was the first FDA-approved surgical robot, which consisted of a voice-activated system and robotic arm for endoscopic camera control to replace a surgical assistant in laparoscopy. HERMES was then developed to give the surgeon voice-activated control over the camera, light source, insufflation, printer, phone, operating room lights, and the patient table position. Two robotic arms and a surgeon console were implemented in the ZEUS surgical system that was used in 1999 for cardiac surgery and then FDA approved for laparoscopic surgery in 2001. In 2005, the FDA approved the current robotic platform, the da Vinci surgical system. The advancements of the previous devices were incorporated into this system, along with many others.
2020 ACOG guidelines on robot-assisted gynecologic surgery
The American College of Obstetricians and Gynecologists (ACOG) released guidelines on robot-assisted gynecologic surgery that include the following :
Robot-assisted cases should be appropriately selected based on the available data and expert opinion. In addition to the didactic and hands-on training necessary for any new technology, ongoing quality assurance is essential to ensure appropriate use of the technology and, most importantly, patient safety.
Adoption of new surgical techniques should be driven by what is best for the patient, as determined by evidence-based medicine rather than external pressures.
Adequate informed consent should be obtained from patients before surgery. In the case of robotic procedures, this includes a discussion of the indications for surgery and risks and benefits associated with the robotic technique compared with alternative approaches and other therapeutic options.
Surgeons should describe their experience with robotic-assisted surgery or any new technology when counseling patients regarding these procedures.
Surgeons should be skilled at abdominal and laparoscopic approaches for a specific procedure before undertaking robotic approaches.
Surgeon training, competency guidelines, and quality metrics should be developed at the institutional level.
Reporting of adverse events is currently voluntary and unstandardized, and the true rate of complications is not known. The American College of Obstetricians and Gynecologists and the Society of Gynecologic Surgeons recommend the development of a registry of robot-assisted gynecologic procedures and the use of the Manufacturer and User Facility Device Experience Database to report adverse events.